Regional analgesia techniques as adjuncts to general anesthesia in pediatric cardiac surgery: an updated systematic review and meta-analysis of randomized controlled trials

Bruno Francisco Minetto Wegner; Gustavo Roberto Minetto Wegner; Gabriel Lemos González; Vitor Alves Felippe; Alesson Marinho; Tatiana Souza Nascimento; Archit Sharma

doi:10.1136/rapm-2025-107470

Back

Regional analgesia techniques as adjuncts to general anesthesia in pediatric cardiac surgery: an updated systematic review and meta-analysis of randomized controlled trials

Journal article

Peer reviewed

Regional analgesia techniques as adjuncts to general anesthesia in pediatric cardiac surgery: an updated systematic review and meta-analysis of randomized controlled trials

Bruno Francisco Minetto Wegner, Gustavo Roberto Minetto Wegner, Gabriel Lemos González, Vitor Alves Felippe, Alesson Marinho, Tatiana Souza Nascimento and Archit Sharma

Regional anesthesia and pain medicine

03/30/2026

DOI: 10.1136/rapm-2025-107470

PMID: 41912271

View Online

Abstract

BackgroundRegional analgesia (RA) is increasingly used in pediatric cardiac surgery, but evidence supporting its benefit remains fragmented. This systematic review and meta-analysis aimed to determine the “class effect” of RA.MethodsA systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Data sources included PubMed, Embase, Cochrane Library, and Web of Science, searched up to July 10, 2025. We included RCTs of pediatric patients undergoing cardiac surgery that compared any RA technique (neuraxial, peripheral nerve blocks, or local infiltration) against general anesthesia with systemic analgesia alone.Results31 RCTs (n=2245) were included. Adjunctive RA was associated with significant reductions in intraoperative fentanyl (MD −2.50 µg·kg⁻¹; 95% CI −3.84 to −1.15; 95% PI −9.51 to 4.52; I²=97%), 24-hour intravenous morphine (MD −0.33 mg·kg⁻¹; 95% CI −0.55 to −0.11; 95% PI −1.17 to 0.51; I²=96%), and improved recovery. Benefits included shorter time to tracheal extubation (MD −1.72 hours; 95% CI −2.93 to −0.52; 95% PI −7.78 to 4.34; I²=99%), reduced ICU stay (MD −0.25 days; 95% CI −0.34 to −0.16; 95% PI −0.61 to 0.11; I²=93%), and prolonged time to first analgesia (MD 2.95 hours; 95% CI 1.86 to 4.04; 95% PI -1.42 to 7.31; I²=97%). Subgroup analyses showed outcome-specific, inconsistent effects.ConclusionThere is very low to low certainty of evidence that adjunctive RA is associated with reduced opioid exposure and improved recovery in pediatric cardiac surgery. Substantial heterogeneity and imprecision markedly reduce confidence in the estimated effects, which should therefore be interpreted cautiously.RegistrationPROSPERO CRD420251073543.

Analgesics, Opioid

Meta-Analysis

Pain, Postoperative

Pediatric Anesthesia

REGIONAL ANESTHESIA

Review

Details

Title: Subtitle: Regional analgesia techniques as adjuncts to general anesthesia in pediatric cardiac surgery: an updated systematic review and meta-analysis of randomized controlled trials
Creators: Bruno Francisco Minetto Wegner - Universidade Federal do Rio Grande do Sul
Gustavo Roberto Minetto Wegner - Universidade de Passo Fundo
Gabriel Lemos González - Universidade Federal do Estado do Rio de Janeiro
Vitor Alves Felippe - Instituto Nacional de Câncer - INCA
Alesson Marinho - Universidade Federal de São Paulo
Tatiana Souza Nascimento - University of Iowa
Archit Sharma - University of Iowa
Resource Type: Journal article
Publication Details: Regional anesthesia and pain medicine
DOI: 10.1136/rapm-2025-107470
PMID: 41912271
NLM abbreviation: Reg Anesth Pain Med
ISSN: 1098-7339
eISSN: 1532-8651
Publisher: BMJ Publishing Group Ltd
Grant note: The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Language: English
Electronic publication date: 03/30/2026
Academic Unit: Anesthesia
Record Identifier: 9985149571302771

Metrics

2 Record Views

See more details